PMT16-02420 City of Menifee Permit No.: PMT16-02420
29714 HAUN RD. Type: Residential Plumbing
< -ICCELA? MENIFEE, CA 92586
MENIFEE Date Issued:
07/29/2016
PERMIT
Site Address: 28894 GOLDEN DAWN DR, MENIFEE, Parcel Number: 372-352-018
CA 92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
GARY BALDWIN ALL STAR WATER HEATERS INC
28894 GOLDEN DAWN DRIVE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 MENIFEE,CA 92584
Applicant Phone:9513010067
SIERRA SPRAGUE License Number:812894
ALL STAR WATER HEATERS INC
30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584
Fee Description 911K Amount ISl
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 4.15
$115.16
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing building operations being carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bidg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ [am exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of
License Class License No. P/e?,p improvements covered by this permit,I cannot legally sell a structure that I have
Expires 3e Signature built as an owner-building if if has not been constructed in its entirety,by licensed
contractors. I understand that a copy of the applicable law. Section 7044 of the
WORKERS'COMPENSATION DECLARATIOI Business and Professions Cade,is available upon request when this application is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one the following declarations: htfoJ/www.leoinfo.ca.aov/calaw.html.
I have and will maintain a certificate of consentt of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Dale
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy It ❑ By my Signature below, 1 certify to each of the following: I am the property
OV, I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and slate laws relating to building
construction.I authorize representatives of this city or county to enter the above-
Carrier identified properl or the inspection purposes.
Policy# .P�n//C1�.P494.?A Expires PX�Ln efaO Date
FopertywngOrAuthorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES ❑NO
Applicant; Date;��/G Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: AILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines _
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES ❑NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous material reporting.
OWNER BUILDER DECLARATIONS DYES ❑NO
I hereby affirm under penally of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve,demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
or repair any structure, prior to its issuance,also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in apre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from foensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Finn Name:
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the pmjects with a
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DATE 1 PERMIT/PLAN CHECK NUMBER
TYPE: OCOMNTRCIAL ✓QRESIOENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
NEW EkLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION Of WORI Replace existing water heater. Same size and location.
PROJECTADDRESS IQ8894 golden dawn dr
ASSESSOR'S PARCEL Nt I ABER 0a LOT TRACT
OWNERNAME gary baldwln
ADDRESS 28894 9 Aden dawn or
PHONE is-_ O, 541 EMAIL 1
APPLICANT NAME
ADDRESSE:ffa S ra Ue
ADDRESS 30300 fterta Vallarta
PHONE 951-301-OI _67 ________•_ EMAIL a]lstar.sierra@gmail.com
CONTRACTOR'S NAME Sierra Sprague _ OWNER BUILDER? 0YESbNO
BUSINESS NAME _Al_lj tar Water Heaters
ADDRESS 30300 Puerta Valletta Way _
PHONE 951-301-I 067 EMAIL allstar.sierra@gmail-COm
CONTRACTOR'S STATE IC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 800.00 SQFT _ LSO FT
APPLICANT'S SIGNI, RE r!h- �ri��— DATE
t
CITY OF MENIFEE BUSINESS LICENSE NUMBER
DIF ARTMENTDISTRIBUTIOBUILDING PLANNING E FIRE GREEN SNIIPINVOICE IDAMOUNT O CASH O CHECKS OCREDTCARD MSA/MC
AMOUNTPLAN CHECK FEEID AMOUNT 0cASH OCHECKB OCREDITCARD USAINIC
OWNER BUILDER VERIFi 0YE5 O NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of iV?enr.'.e Bt�ihtirtg u Safe!y Department 797t4 Hour Rd.Menifee, CA 9.:586 95L-o%'-r%77
w,,ulm.Citvo%nanifee.Lis Inspection ReGues Line 951-'46-52.13.
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